VI.

DRUG STUDY

Drug Classification: IMMUNE CHECKPOINT INHIBITOR

Why the drug is given: It is given to help lower the risk of the melanoma coming back.

Mechanism of Action: Binds to the PD1 receptor found on the surface of T cell suppression

and resulting in decreased tumor growth.

Desired Effect: This drug is given to the patient to prevent an immune response from being

so strong that it destroys healthy cells in the body.

Nursing Responsibilities Rationale

Independent:

 Monitor patient closely for signs and  To avoid complications and must

symptoms of hypersensitivity or administer corticosteroid drugs for

infusion reactions. emergency treatment to stop

infusion.

 To be able to know when to

 Monitor patient for immune- withhold or discontinue drug based

mediated pneumonitis (shortness of on grade and give corticosteroids

breath, chest pain, new or worsening instead.

cough).  It may require corticosteroid

 Caution patient about the risk of treatment and interruption of therapy

immune mediated adverse effects. or discontinuation of drug.

Dependent:

 Monitor the patient’s signs and  For immediate intervention to avoid

symptoms of lung problems and complications.

immediately report it to the

physician.
Interdependent:

 Instruct patient to keep laboratory  To monitor drug’s safety and

 appointments as requested by effectiveness.

prescriber.

Drug Classification: MONOCLONAL ANTIBODIES

Why the drug is given: These are cancer treatments that enlist natural immune system

functions to fight cancer.

Mechanism of Action: A murine and human monoclonal antibody directed against CD20

antigen found on the surface of normal and malignant B lymphocytes. Binding to this antigen

mediates the lysis of the B cells.

Desired Effect: This drug is given to patient to help the immune system slow or stop the

growth of cancer cells.

Nursing Responsibilities Rationale

Interdependent:

 Monitor patient’s BP closely during  To avoid hypotension,

infusion. bronchospasm, or angioedema.

 Withhold antihypertensives 12 hours  Transient hypotension may occur.

before infusion.
Dependent:

 Administer drugs such as  To perform immediate intervention

epinephrine, antihistamines and and avoid complications.

corticosteroids if signs and

symptoms of hypersensitivity

occurs.
Interdependent:

 Refer patient to laboratories for the  To avoid complication of

screening for HBV infection before chemotherapy such as Hepatitis B

treatment by measuring HbsAg and virus (HBV) reactivation and to

 hepatitis B core antibody. apply proper treatment if HBV

reactivation occurs.

Drug Classification: BRAF INHIBITOR

Why the drug is given: These drugs can shrink or slow the growth of tumors in some

people whose melanoma has spread or can’t be remove completely.

Mechanism of Action: It works by attacking the BRAF protein directly to stop the

development of many different types of cancer including melanoma.

Desired Effect: This drug is given to the patient after surgery with stage III melanoma,

where it can help lower the risk of the cancer coming back.

Nursing Responsibilities Rationale

Independent:

 Monitor patient’s body temperature  To avoid or prevent hyperthermia

and administer antibiotic or low- immediately.

dose prednisolone.

 Instruct patient to take drug as  To ensure that the medicine is

directed at least 1 hour or 2 hours absorbed into the bloodstream

after meal. effectively

 Assess patient for signs and  To avoid outbreaks of severe rash

symptoms of photosensitivity. that may occur upon exposure to

ultraviolet light or to sunlight.

Dependent:

 Administer antihistamines as  To relieve allergy symptoms and

prescribed by the physician. skin rash.

Interdependent:

 Refer patient to the ophthalmologist  To check for ocular toxicity.

if experiencing blurred vision.

Drug Classification: MEK INHIBITOR

Why the drug is given: to inhibit growth of tumor cells.

Mechanism of Action: MEK inhibitor bind to and inhibit MEK, inhibiting MEK-dependent

cell signaling. The inhibition leads to cell death and the inhibition of tumor growth. These are

allosteric binding inhibitors of MEK which inhibit either MEK1 alone, or both MEK1 and

MEK2.

Desired Effect: this drug is given to the patient to stop the growth of tumor cells by blocking

proteins needed for cell growth.

Nursing Responsibilities Rationale

Independent:

 Monitor BP periodically during  To provide proper treatment when

therapy. hypertension occurs.

 Monitor body temperature during  To provide proper treatment when

therapy. serious febrile occurs.

 Discontinue drug if cough, dyspnea,  To avoid serious interstitial lung

hypoxia, pleural effusion, and disease.

infiltrates occurs.
Dependent:

 Evidence of BRAF V600E or  To identify patients for whom

V600K mutation within the tumor treatment with MEKINIST is

specimen is necessary. indicated.

Interdependent:

 Refer patient to ophthalmologist and  To avoid serious complications and

cardiologist for cardiac and to provide proper and effective

ophthalmologic side effects. treatment.

 Advise patient of the potential risk  To provide information to the patient

for impaired spermatogenesis, and to prior to treatment to gain patient’s

seek counseling on fertility and cooperation throughout the process

family planning options prior to of therapy.

starting treatment MEKINIST.